Psychiatry in the media

The media has considerable power
and influence over us. Yet often the presentation of mental illness
through the press, television, radio and on film can be
unbalanced. For example, selective reporting of a few high profile
cases has fuelled distorted stereotypes of individuals with
schizophrenia as being violent. Hollywood films such as Alfred
Hitchcock’s ‘Psycho’ (1960) have probably added to these
misunderstandings by suggesting schizophrenia means having a
‘split’ or dual personality. However, it is most unusual for people
with psychosis to be dangerous, and the overwhelming majority of
murders are committed by those without any mental illness.

Another popular media stereotype is
the black couch, the means by which the psychiatrist will ‘read
minds’ and single-handedly uncover a person’s deepest secrets. In
reality, patients sit in chairs whilst describing their problems,
and psychiatrists typically work in multidisciplinary teams
alongside nurses, social workers and other professionals. The
focus is often upon pragmatic solutions, using medication, social
approaches and a range of talking treatments (such as cognitive
behavioural, family and dynamic therapies).

By contrast, evidence-based
treatments are often portrayed on screen in a stigmatising way. The
1975 film ‘One Flew Over the Cuckoo’s Nest’ -starring Jack Nicolson
- painted electroconvulsive therapy (ECT) as a barbaric and
impotent tool for social control. Surveys have revealed that people
who have seen this movie are ‘put off’ ECT and would actively try
to dissuade a family member from receiving it. Yet modern ECT has
been shown to be a safe, effective treatment for severe,
life-threatening depressive illness.

Why does mental health often
attract such unbalanced media coverage? To understand this, it is
worth remembering the main goals of those who work in the media -
to attract and sell (always), to entertain (frequently), and to
inform or educate (sometimes). A headline reporting that ‘GPs
provide satisfactory care for depression’ would be unlikely to grip
the public’s attention. This helps to explain the ‘all or nothing’
approach behind the commonest types of news story: the cover-up or
scandal (eg ‘Care in the Community Fails Millions’), the
human-interest angle (‘My Battle Against Anorexia’), and the
scientific breakthrough (‘New Wonder Drug for Dementia’).

Yet the media can also be a
significant force for the good - by promoting greater awareness and
knowledge of mental disorders. People now talk about ‘depression’
more openly than they did in the past. Celebrities who use the
media to disclose their own mental health problems can be
particularly helpful in reducing stigma. For example, the actor
Stephen Fry has presented several TV programmes that explore
bipolar (manic depressive) disorder. The 2001 film, A Beautiful
Mind (about Nobel-Prize winning Mathematician John Nash), showed
that people battling schizophrenia could be brilliant. And TV soap
operas can sometimes increase their viewers’ knowledge about
important issues,such as the effects of an impulsive overdose of
paracetamol (delayed but serious liver damage). Even media stories
that wrongly label antidepressants as ‘addictive’ still remind
psychiatrists to tell patients not to stop taking their
antidepressant medication suddenly as this may lead to a
discontinuation reaction.

New forms of mass media are
constantly adding to the ways in which people receive information
about mental disorders. Examples include handheld computers, mobile
phones and the internet. Modern technologies allow individuals to
access treatments with an evidence base (e.g. computerised
cognitive behaviour therapy) as well as engaging in less regulated
areas such as self-help websites and cyber chat rooms.
Unfortunately, like other media sources, not all the information
that is freely available online is reliable, impartial or of high
quality.

Some psychiatrists have become well
known through the media. Anthony Clare (1942-2007) was a respected
TV and radio presenter who conducted probing interviews of
well-known figures on his programme ‘In the Psychiatrist’s Chair’.
By contrast, most doctors are happy to practice clinically outside
the media spotlight. However, they occasionally come under pressure
from reporters and interviewers to offer opinions. The Public
Education Department of the Royal College of Psychiatrists provides
advice and training on dealing with the media. A sensible approach
is to make only one or two points well (rather than many), and not
become tempted to stray outside one’s area of expertise. It is also
important for psychiatrists to respect the confidentiality of any
patient under their care, and to remember that they are entitled to
make no comment at all.

In the half-century since ‘Psycho’
was made, what progress has been made in combating unhelpful
stereotypes about mental health? Over the past few years, the Royal
College of Psychiatrists has led a number of public education
initiatives to improve public understanding and tolerance of mental
disorders. These have included the Defeat Depression Campaign
(‘depression is common, recognisable and treatable’) and the
Changing Minds (anti-stigma) Campaign (which produced ‘1 in 4’ - a
cinema film reflecting how mental illness can affect anyone). More
recently the College’s Fair Deal Campaign has sought to promote
equality in mental health care. This includes a fair deal in terms
of media coverage. In an age when we are surrounded by images and
soundbites, the presentation of good psychiatric care (as well as
the care itself) is an important challenge.

For those who are considering a
career in psychiatry, now has never been a better time to influence
the public face of mental health. Consider the number of TV dramas,
news stories, magazine articles and novels dedicated to unravelling
people’s minds. Psychiatrists are doctors who deal with how the
mind works. They can harness that public fascination within their
daily practice – to promote tolerance, understanding and
innovation. Add to this the fact that almost everyone knows someone
with a mental health problem, and the resulting ‘headline’ news is
that 21st century psychiatrists are ideally placed to engage with
patients, the public and the media alike.